# MC 5 INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MCCULLOUGH'S LTC PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437313384
- **Authorized official:** ROBERT MCCULLOUGH (PRESIDENT)
- **Authorized official phone:** (262) 473-5087

## Contact information

- **Practice address:** 1173 W MAIN ST, STE F, WHITEWATER, WI 53190-1672
- **Practice address phone:** (262) 473-5087
- **Practice address fax:** (262) 473-7357
- **Mailing address:** 1173 W MAIN ST, STE F, WHITEWATER, WI 53190-1672
- **Mailing address phone:** (262) 473-5087
- **Mailing address fax:** (262) 473-7357

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 885142 | WI | Yes |

## Other

- **Enumeration date:** 07/10/2008
- **Last updated:** 08/21/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2116684 | PK | — |